Day of Action Volunteer Signup Form

Day of Action (formerly Community Care Day)

Volunteer Sign-up Form

Thank you for signing up to participate in United Way's Day of Action! Please complete the form below. Projects are available on a first come, first serve basis. Volunteers are required to wear closed-toe shoes for this event.

All projects will take place on Friday, June 6, 2008. United Way's Volunteer Connection will email your project assignment to you as soon as possible. Thank you!

I am signing up as:	a group an individual

Group Information:
Organization Name:
Organization Address:
Organization City:
Organization State:
Organization Zip:
Organization Phone Number:
Number of Volunteers:
Age Range of Volunteers:

Please provide the following information about each of the members of your volunteer group.
If you have more than 20 volunteers in your group, please include their information in the comments section of this form.

First and Last Name	Email Address	Day-of-Event Phone	T-Shirt Size

Would your company or organization like to sponsor United Way's Day of Action
by donating money and/or supplies to assist with the completion of the day's projects?

Yes No Not Sure - Please Call Me

Individual / Group Contact Person Information
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:
T-Shirt Size:
Are you at least 18 years old?	Yes No
Are you at least 21 years old?	Yes No

General Information How did you hear about United Way's Day of Action? (please check all that apply)
	www.volunteerdayton.org
	www.myspace.com/volunteerconnection
	www.facebook.com
	dayton.craigslist.org
	Newspaper
	Friend
	My company / organization
	www.volunteermatch.org
	Email from United Way
	United Way Staff Member
	Other

Most projects will be completed between the hours of 8:00am and 4:00pm. Please check all times you are available:
	8:00am - 12:00pm
	12:00pm - 4:00pm
	Other (please describe):

Would you prefer to work a shift of four hours or eight hours?
	Four Hours
	Eight Hours

Which county would you prefer to volunteer in? Please check all that apply:
	Montgomery County
	Greene County
	Preble County

Which neighborhoods are you available to volunteer in? Please check all that apply:
Centerville	Dayton	Dayton - Downtown	Dayton - North
Dayton - West	Dayton - East	Dayton - South	Eaton
Englewood	Fairborn	Huber Heights	Kettering
Riverside	Trotwood	Xenia	Yellow Springs
Other (please describe):

Which skills are you interested in using as a volunteer? Please check all that apply:
Painting	Carpentry	Child Care
Cleaning	Clerical	Friendly Visiting
Construction	Crafts	Electrical
Food Preparation	Heavy Lifting	Landscaping
Basic Maintenance	Plumbing	Sorting
Other (please describe):

Please list any special skills that members of your group may have:

Please list any physical limitations that you or members of your group may have:

If you have a preferred project, please list the name and location below:

Additional notes and comments:

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